Incidence and risk factors for incisional hernia after temporary loop ileostomy closure: choosing candidates for prophylactic mesh placement

Abstract Aim Prophylactic mesh reinforcement has proven to reduce the incidence of incisional hernia (IH). Fear of infectious complications may withhold the widespread implementation of prophylactic mesh reinforcement, particularly in the onlay position. Material and Methods Patients scheduled for elective midline surgery were randomly assigned to a suture closure group, onlay mesh group, or sublay mesh group. The incidence, treatment, and outcomes of patients with infectious complications were assessed through examining the adverse event forms. Data were collected prospectively for 2 years after the index procedure. Results Overall, infectious complications occurred in 14/107 (13.3%) patients in the suture group and in 52/373 (13.9%) patients with prophylactic mesh reinforcement (p = 0.821). Infectious complications occurred in 17.6% of the onlay group and 10.3% of the sublay group (p = 0.042). Excluding anastomotic leakage as a cause, these incidences were 16% (onlay) and 9.7% (sublay), p = 0.073. The mesh could remain in-situ in 40/52 (77%) patients with an infectious complication. The 2-year IH incidence after onlay mesh reinforcement was 10 in 33 (30.3%) with infectious complications and 15 in 140 (9.7%) without infectious complications (p = 0.003). This difference was not statistically significant for the sublay group. Conclusions Prophylactic mesh placement was not associated with increased incidence, severity, or need for invasive treatment of infectious complications compared with suture closure. Patients with onlay mesh reinforcement and an infectious complication had a significantly higher risk of developing an incisional hernia, compared with those in the sublay group.

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Long-term Follow-Up of Prophylactic Mesh Reinforcement After Emergency Laparotomy. Cohorts Study.

10.21203/rs.3.rs-104602/v1 ◽

2020 ◽

Author(s):

Alejandro Bravo-Salva ◽

Nuria Argudo-Aguirre ◽

Ana María González-Castillo ◽

Estela Membrilla-Fernandez ◽

Joan Sancho-Insenser ◽

...

Keyword(s):

Risk Factors ◽

Incisional Hernia ◽

Long Term Results ◽

Emergency Laparotomy ◽

Prophylactic Mesh ◽

Midline Laparotomy ◽

Incisional Hernias ◽

Mesh Reinforcement

Abstract BackgroundPrevention of incisional hernias with a prophylactic mesh in emergency surgery is controversial. The present study aimed to analyze the long-term results of prophylactic mesh used for preventing incisional hernia after emergency midline laparotomies. MethodsThis study was a registered (NCT04578561) retrospective analysis of patients who underwent an emergency midline laparotomy between January 2009 and July 2010 with a follow-up period of longer than 2 years. Long-term outcomes and risk factors for the development of incisional hernias between patients who received a prophylactic reinforcement mesh (Group M) and suture (Group S) were compared. ResultsFrom an initial 266 emergency midline laparotomies, 187 patients were included. The median follow-up time was 64.4 months (SD 35). Both groups had similar characteristics, except for a higher rate of previous operations (62% vs. 43.2%; P=0.01) and operation due to a revision laparotomy (32.5% vs. 13%; P=0.02) in the M group. During follow-up, 29.9% of patients developed an incisional hernia (Group S 36.6% vs. Group M 14.3%; P=0.002). Chronic mesh infections were diagnosed in 2 patients, but no mesh explants were needed, and no patient in the M group developed chronic pain. Long-term risk factors for incisional hernia were as follows: smoking (HR=2.47; 95% CI 1.318–4.624; P=0.05), contaminated surgery (HR=2.98; 95% CI 1.142–7.8; P=0.02), surgical site infection (SSI; HR=3.83; 95% CI 1.86–7.86; P=0.001), and no use of prophylactic mesh (HR=5.09; 95% CI 2.1–12.2; P=0.001). ConclusionIncidence of incisional hernias after emergency midline laparotomies is high and increases with time. High-risk patients, contaminated surgery, and SSI benefit from mesh reinforcement. Prophylactic mesh use is safe and feasible in emergencies with a low long-term complication rate.

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Incidence and risk factors of delayed development for stoma site incisional hernia after ileostomy closure in patients undergoing colorectal surgery with temporary ileostomy

Acta Chirurgica Belgica ◽

10.1080/00015458.2020.1846941 ◽

2020 ◽

pp. 1-7

Author(s):

Pablo Calvo Espino ◽

Arsenio Sánchez Movilla ◽

Isabel Alonso Sebastian ◽

Jesús García Schiever ◽

David Varillas Delgado ◽

...

Keyword(s):

Risk Factors ◽

Colorectal Surgery ◽

Incisional Hernia ◽

Ileostomy Closure ◽

Stoma Site ◽

Temporary Ileostomy ◽

Delayed Development

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O30 THE INCIDENCE OF INCISIONAL HERNIA AT OSTOMY-REVERSAL SITE

British Journal of Surgery ◽

10.1093/bjs/znab396.029 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Jurij Gorjanc ◽

Raphael Edlinger ◽

Magdalena Rosenkranz ◽

Jörg Tschmelitsch

Keyword(s):

Incisional Hernia ◽

Surgical Complication ◽

Statistical Significance ◽

Loop Ileostomy ◽

Prophylactic Mesh ◽

Mesh Implantation ◽

Incisional Hernias ◽

Stoma Reversal ◽

Hernia Incidence ◽

High Bmi

Abstract Aim The purpose of this study was to evaluate the rate of incisional hernias at the ostomy site after reversal of the ostomy. Material and Methods We used retrospectively compiled database of patients who had undergone ostomy formation and ist reversal. All patients had their surgery performed between Jan. 2011 and December 2019. Patients history, added by clinical examination and CT-scan were performed in order to identify the incidence of incisional hernias. Different variables, like gender, surgical site infection (SSI) and BMI were evaluated as possible risk factors for hernia occurrence. Results Among totally included 224 patients in the study, 190 of all patients had reversal after loop-ileostomy (85%) and 34 patients had reversal after loop-colostomy (15%). Among all stoma reversal patients, 12,8 % developed incisional hernia at the stoma reversal site (n = 28). The incisional hernia occurrence at the ostomy reversal site was present in 20,0% in patients with clinically relevant SSI and only in 9,4% in patients where SSI was absent (p = 0,03). There was no statistical significance in hernia occurrence between both genders and among patients with low, normal and high BMI in our cohort of patients. Conclusions Incisional hernia after ostomy reversal is a common late surgical complication. All measurements that reduce SSI at the reversal site are important for lower hernia incidence. Prophylactic mesh implantation at stoma reversal sites may be considered in these patients.

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